Mental Health Self Check-in
A private weekly check-in on mood, sleep, energy, and coping – for programmes and practices.
4 questions · 1 page · about 2 minutes to answer · fully editable after you start
Between sessions is where most of a client's week happens. This gentle self check-in – mood, sleep, energy, and how well coping strategies held up – gives practitioners a weekly picture without asking clients to journal, and gives clients a habit of noticing their own patterns.
Use an anonymous collector for group programmes, or a personal link per client in individual care. The trend matters more than any single week; a two-week slide in the same direction is the conversation starter.
Replace [local emergency number, e.g. 000] and [local crisis line, e.g. Lifeline on 13 11 14] in its opening note with the services where your respondents live, before you share it: the numbers shown are Australia's. The Collect tab lists both until they are changed.
Template preview
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Page 1
This week
Use this to take stock of the past week. It is a way to notice how you are doing, and it is not a diagnosis. It takes about 2 minutes.
This check-in is not a crisis service. If you are in immediate danger, call [local emergency number, e.g. 000]. For crisis support at any time, call [local crisis line, e.g. Lifeline on 13 11 14].
Q1.Overall, how has your mood been this week?*
Q2.How were these this week?
| Poor | Mixed | Good | Not applicable | |
|---|---|---|---|---|
| Sleep | ||||
| Energy | ||||
| Appetite | ||||
| Concentration |
Q3.When things got hard, how well did your coping strategies work?
- Well - I used them and they helped
- Partly
- I struggled to use them
- It was not a hard week
Q4.Anything you want to note or bring to your next session?
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